Mediastinitis

Abstract

Mediastinitis is a rare but a serious complication of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). We present 3 cases of mediastinitis following these diagnostic procedures. In 2 of the patients oropharyngeal bacteria were found in the cultures from the mediastinal abscess. All 3 cases were treated successfully with thoracotomy and drainage of the abscess together with intravenous antibiotics. On the basis of these cases and an updated review of the literature we discuss the most likely etiology for mediastinitis in association with EBUS-TBNA and EUS-FNA procedures and propose how to reduce the risk for this serious complication. The possibility of mediastinitis should always be kept in mind when a patient complains of fever over a long period of time as well as chest pain and malaise after an EBUS-TBNA or EUS-FNA procedure.

Surgical treatment for mediastinal abscess induced by endobronchial ultrasound-guided transbronchial needle aspiration: a case report and literature review

“…The most common treatment is thoracotomy with chest tube drainage and intravenous antibiotics [6, 8, 9, 11, 13–15]. In 4 cases, intravenous antibiotics alone were administered for 7 to 30 days and surgical debridement was unnecessary [4, 5, 9, 10].…”

“…In 4 cases, intravenous antibiotics alone were administered for 7 to 30 days and surgical debridement was unnecessary [4, 5, 9, 10]. The indication for the procedure was malignancy in 10 cases, particularly lymph node metastasis of lung cancer in 6 cases [4, 5, 8, 10, 11, 15]. In addition, the indications were sarcoidosis in 3 cases [12, 15] and nonspecific inflammatory changes in another 3 [7, 13, 14].…”

“…The indication for the procedure was malignancy in 10 cases, particularly lymph node metastasis of lung cancer in 6 cases [4, 5, 8, 10, 11, 15]. In addition, the indications were sarcoidosis in 3 cases [12, 15] and nonspecific inflammatory changes in another 3 [7, 13, 14]. The implicated bacteria were of oropharyngeal origin, e.g., Klebsiella pneumonia [14], Actinomyces [15], hemolytic Streptococcus [9, 13], and Streptococcus intermedius [7].…”

“…In addition, the indications were sarcoidosis in 3 cases [12, 15] and nonspecific inflammatory changes in another 3 [7, 13, 14]. The implicated bacteria were of oropharyngeal origin, e.g., Klebsiella pneumonia [14], Actinomyces [15], hemolytic Streptococcus [9, 13], and Streptococcus intermedius [7]. No bacteria were detected in 3 cases, and the early administration of antibiotics eliminated the infectious pathogens.…”

“…It is a useful tool not only for the staging of lung cancer but also for the diagnosis of diseases such as sarcoidosis and metastatic malignancy [2]. Although complications associated with EBUS-TBNA are rare [3], infectious complications have been reported [4–15]. We report a case of mediastinitis resulting from an infection after EBUS-TBNA which we successfully treated with prompt surgical drainage.…”